Complicated Grief and Widows

Q. I’ve heard that some widows experience “complicated grief.” How does it differ from ordinary grief, and who’s at risk? I’m a widow myself.

Grief is the emotional and physical response to the death of a loved one, featuring symptoms such as sadness, anxiety, panic, numbness, fatigue, shock. After my own husband died, I walked around in a daze, with what seemed like a transparent film over my eyes. The grief process had a purpose, however, gradually helping me adapt to the greatest loss of my life and start functioning again. Complicated grief (CG) is something else: prolonged intense grief that leaves the bereaved unable to heal and move ahead. CG, which is different from depression, can also worsen over time. Signs of CG include the inability to accept the reality of the death, yearning for the deceased, deep sadness, social withdrawal (at the very time support is so vital), and suicidal thoughts.

Risk Factors

Complicated grief is associated with the death of someone extremely close, such as a spouse or a child — and older women are particularly at risk. The older you are, the more likely you are to lose family members and friends. A population survey of bereaved ages 14 to 95 years, published in 2011 in the Journal of Affective Disorders, reported a 6.7 percent incidence of CG. Among those 61 and older, 9 percent of subjects (and 9.6 percent of older women) developed CG, a much higher rate than in younger people.

Sudden and traumatic loss, as in acts of terrorism or mass violence or natural disasters, can also trigger CG. Death by suicide puts those left behind at risk, too, as feelings of guilt, anger, rejection, shame, and stigma compound the tragedy.

Treatment Breakthrough

Complicated grief is difficult to treat. But research results in the November 2014 issue of JAMA Psychiatry offer reasons for optimism. Over 150 older adults suffering from CG (mainly female, mean age 66) participated in the first randomized clinical trial for treatment. Subjects received 16 sessions of targeted treatment for CG — or a proven effective treatment for depression (IPT). In the first group, 70 percent showed improvement versus one-third of those receiving IPT. The study’s lead author, M. Katherine Shear, M.D., professor of psychiatry at the Columbia School of Social Work, is also director of the Center for Complicated Grief.